Overview of carpal fractures
- Kevin deWeber, MD, FAAFP, FACSM
Kevin deWeber, MD, FAAFP, FACSM
- Family Medicine of SW Washington Residency
- PeaceHealth SW Medical Center
- Affiliate Associate Professor of Family Medicine
- Oregon Health and Science University
- Clinical Instructor of Family Medicine
- University of Washington School of Medicine
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
The carpals are the bones of the wrist between the radius and ulna proximally, and the metacarpals distally. These eight bones are collectively termed the carpus and are commonly divided into the proximal carpal row—scaphoid, lunate, triquetrum, and pisiform—and the distal row—trapezium, trapezoid, capitate and hamate. In general, carpal fractures occur from either direct or indirect trauma.
This topic provides an overview of basic carpal anatomy, mechanisms of injury, general principals of examination and imaging, and the initial care of adults with carpal fractures. More detailed discussions of common and important wrist injuries are presented separately. (See "Evaluation of the adult with subacute or chronic wrist pain" and "Evaluation of the adult with acute wrist pain" and "Distal radius fractures in adults" and "Scaphoid fractures" and "Triquetrum fractures" and "Lunate fractures" and "Capitate fractures" and "Hamate fractures".)
EPIDEMIOLOGY— Hand fractures are among the most common of extremity injuries, accounting for about 18 percent of all fractures. Carpal fractures comprise upwards of 8 percent of hand fractures [1-3]. Scaphoid fractures are by far the most common of the carpal fractures, and account for 10 percent of all hand fractures and 60 to 70 percent of all carpal fractures [4,5]. The triquetrum is the second most common carpal fracture, comprising between 13 and 28 percent. Fractures of the trapezium, hamate, capitate and trapezoid follow in prevalence, ranging from 2 to 4 percent of carpal fractures. The pisiform is the rarest carpal fracture at 0.5 to 1 percent [1,6-8].
CLASSIFICATION AND CLINICAL PRESENTATION
Carpal fractures are classified primarily by the anatomic location of the fracture (see 'Clinical anatomy' below) and secondarily based upon the features of the injury, including associated displacement, dislocation, and the number of fragments produced by the fracture (comminuted versus noncomminuted).
It is important to note that a significant proportion of carpal fractures involve multiple carpal bones, so if one carpal is fractured, the clinician should search for others.
- van Onselen EB, Karim RB, Hage JJ, Ritt MJ. Prevalence and distribution of hand fractures. J Hand Surg Br 2003; 28:491.
- Suh N, Ek ET, Wolfe SW. Carpal fractures. J Hand Surg Am 2014; 39:785.
- Urch EY, Lee SK. Carpal fractures other than scaphoid. Clin Sports Med 2015; 34:51.
- Alshryda S, Shah A, Odak S, et al. Acute fractures of the scaphoid bone: Systematic review and meta-analysis. Surgeon 2012; 10:218.
- Duckworth AD, Jenkins PJ, Aitken SA, et al. Scaphoid fracture epidemiology. J Trauma Acute Care Surg 2012; 72:E41.
- Welling RD, Jacobson JA, Jamadar DA, et al. MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. AJR Am J Roentgenol 2008; 190:10.
- Balci A, Basara I, Çekdemir EY, et al. Wrist fractures: sensitivity of radiography, prevalence, and patterns in MDCT. Emerg Radiol 2015; 22:251.
- Hey HW, Chong AK, Murphy D. Prevalence of carpal fracture in Singapore. J Hand Surg Am 2011; 36:278.
- Geissler WB, Slade JF. Fractures of the carpal bones. In: Green's Operative Hand Surgery, 6th ed, Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH (Eds), Churchill Livingstone, 2011.
- Ingari JV. Wrist and hand. In: DeLee and Drez's Orthopedic Sports Medicine Principles and Practice, 3rd ed, DeLee JC, Drez D, Miller MD. (Eds), Saunders Elsevier, Philadelphia 2010.
- Kaewlai R, Avery LL, Asrani AV, et al. Multidetector CT of carpal injuries: anatomy, fractures, and fracture-dislocations. Radiographics 2008; 28:1771.
- Murthy NS, Ringler MD. MR Imaging of Carpal Fractures. Magn Reson Imaging Clin N Am 2015; 23:405.
- Gaebler C, McQueen MM. Carpus fractures and dislocations. In: Rockwood and Green's Fractures in Adults, 7th ed, Bucholz RW, Heckman JD, Court-Brown CM, Tornetta P (Eds), Lippincott, Williams, & Wilkins, Philadelphia 2010.
- Eiff MP, Petering RC. Carpal fractures. In: Fracture Management for Primary Care, 3rd ed, Eiff MP, Hatch RL (Eds), Saunders, Philadelphia 2013.
- Marchessault J, Conti M, Baratz ME. Carpal fractures in athletes excluding the scaphoid. Hand Clin 2009; 25:371.
- CLASSIFICATION AND CLINICAL PRESENTATION
- Brief description of fractures
- CLINICAL ANATOMY
- MECHANISM OF INJURY
- Axial loading
- Wrist hyperextension
- Wrist hyperflexion
- Deviation, traction, or rotation
- Direct blow to the palmar surface
- Combinations of forces
- SYMPTOMS AND EXAMINATION FINDINGS
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR SURGICAL REFERRAL
- ADDITIONAL RESOURCES
- INFORMATION FOR PATIENTS